British journal of anaesthesia
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Case Reports
Prolonged myotonia and dystonia after general anaesthesia in a patient taking gabapentin.
This is the report of a 55-yr-old female who developed severe myotonia and dystonia after general anaesthesia. Before starting on gabapentin therapy for a neuropathic pain condition, she had undergone numerous uneventful general anaesthetics. ⋯ The events were unrelated to the choice of anaesthetic or anti-emetic. The most recent event that required a protracted stay in hospital after a day-case surgery is presented in detail, and the possible mechanisms to explain the interaction are discussed.
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Experimental evidence from a murine model of traumatic brain injury (TBI) suggests that hypothermia followed by fast rewarming may damage cerebral microcirculation. The effects of hypothermia and subsequent rewarming on cerebral vasoreactivity in human TBI are unknown. ⋯ After moderate hypothermia, rewarming exceeding the 37 degrees C threshold is associated with a significant increase in average PRx, indicating temperature-dependent hyperaemic derangement of cerebrovascular reactivity.
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Clinical Trial
Remifentanil-midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery.
Sedation of critically ill children requiring artificial ventilation remains a therapeutic challenge due to large individual variation in drug effects and a paucity of knowledge of pharmacokinetics in this population. This study aimed to determine the pharmacokinetics of remifentanil in children requiring ventilation after cardiac surgery. ⋯ A combination of remifentanil and midazolam provided satisfactory sedation for these patients. Owing to enhanced clearance rates, smaller (younger) children will require higher remifentanil infusion rates than larger (older) children and adults to achieve equivalent blood concentrations.
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Randomized Controlled Trial Comparative Study
Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort.
Intubation without muscle relaxant is associated with greater incidence of sore throat, hoarseness, hypotension, bradycardia and intubation difficulty.
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